Next-Generation Robotic Spine Surgery: First Report on Feasibility, Safety, and Learning Curve

• Published in: Operative neurosurgery (Hagerstown, Md.) Vol. 17; no. 1; pp. 61 - 69
• Main Authors: Khan, Asham, Meyers, Joshua E, Siasios, Ioannis, Pollina, John
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-07-2019; Wolters Kluwer Health, Inc
• Subjects: Accuracy; Back surgery; Degenerative disc disease; Diseases; Methods; Neurosurgery; Novels; Radiation (Physics); Robotic surgery; Robotics; Robots; Spinal surgery; Spondylolisthesis; Surgery; Technology; Time; Israel; Mazor X; Spinal stabilization; Robotic guidance; Pedicle screws
• ISSN: 2332-4252; 2332-4260
• DOI: 10.1093/ons/opy280

Abstract
Background
Pedicle screw placement is a commonly performed procedure. Robot-guided screw placement is a recent technological advance that has shown accuracy and reliability with first-generation platforms.
Objective
To report our initial experience with the safety, feasibility, and learning curve associated with pedicle screw placement utilizing next-generation robotic guidance.
Methods
A retrospective chart review was conducted to obtain data for 20 patients who underwent lumbar pedicle screw placement under robotic guidance after undergoing interbody fusion for lumbar spinal stabilization for degenerative disc disease with or without spondylolisthesis. The newest generation Mazor X (Mazor Robotics Ltd, Caesarea, Israel) was used. Accuracy of screw placement was determined to be grade I to IV. Grade I was in the pedicle (no breach/deviation), grade II was breach < 2 mm, grade III was breach 2 to 4 mm, and grade IV was breach >4 mm; breach direction (superior, lateral, inferior, or medial) was also recorded.
Results
Twenty patients underwent robotically assisted pedicle screw placement of 75 screws at 24 levels. Seventy-four screw placements (98.7%) were grade I; 1 (1.3%) was grade II (medial). No complications occurred. Mean time for screw insertion was 3.6 min. Mean fluoroscopy time was 13.1 s and mean radiation dose was 29.9 mGy.
CONCLUSION
We found that next-generation robotic spine surgery was safe and feasible with reliable and precise accuracy and a minimal learning curve. As this technology improves, further novel applications are expected to develop. Further research is needed to determine long-term efficacy.